Jean E. Johnson

Altering Children's Distress Behavior During Orthopedic Cast Removal

The hypothesis tested was that discrepancy between expected and experienced physical sensations (what is felt, seen, heard, tasted, and smelled) during a threatening experience will result in distress. The subjects were 84 children, 6 to 11 years of age, male and female. The threatening experience was orthopedic cast removal. Tape recorded preparatory information was used to vary systematically expectations about physical sensations. The children were randomly assigned to one of three information groups: 1) sensory information which described the sensory experience during cast removal, 2) procedure information which described the steps of the experience, 3) control group which heard no tape recorded information. Nonverbal and verbal signs of distress reactions and the pulse rate were observed during cast removal. Signs of distress were scaled from zero to two, with zero meaning no distress behaviors and two, high distress behavior. A two-factor analysis of variance (two levels of pre-fear and three levels of information) was used for analysis. As hypothesized, the mean distress score for the sensation group (.50) differed significantly from the control group mean (1.00, p < .025). The procedure group distress score mean (.71) fell between the sensation and control group means but did not differ significantly from the control group mean. The no pre-fear group distress score mean (.52) was significantly lower than the some pre-fear group mean (1.00, p < .02). Mean pulse rate changes for information groups for before to during cast removal were in the same order as the distress scores, but the differences were not statistically significant. The findings were similar to those from other tests of the hypothesis.

CONTRIBUTION OF EMOTIONAL AND INSTRUMENTAL RESPONSE PROCESSES IN ADAPTATION TO SURGERY

Predispositional measures of anxiety, internal-external control, and situational measures of worry, fear, pain, speed of recovery, and doses of analgesics were obtained from 62 female surgical patients. Preoperative measures of fear and worry were (a) positively and linearly related to postoperative emotionality and (/>) unrelated to speed of postoperative recovery and doses of analgesics. Birth order (first and later) and manifest anxiety (high, medium, and low) affected emotionality. Later borns low in manifest anxiety were least emotional; later borns high in manifest anxiety and firstborns either high or low in manifest anxiety were most emotional. Internal-external control was associated with ability to influence care. Internals obtained more needed analgesics, and if they were also firstborn, they had longer hospital stays than externals. The evidence contradicts the hypothesis that preoperativc emotion is causally related to adaptive responses in this stressful situation. The data suggest that emotionality should lie treated as a response and that these responses and instrumental responses can be independent.

The Effects of Cognitive and Behavioral Control on Coping with an Aversive Health Examination

The effects of cognitive and behavioral control on coping with an aversive health examination were tested in a 2 x 2 factorial design. Cognitive control was represented by sensory or health-education information; instruction or no instruction in abdominal relaxation constituted the levels of behavioral control. The study was conducted in the natural setting of a family-planning clinic with 24 young women who were undergoing a routine pelvic examination. Subjects who received sensory information prior to the examination showed less distress, as indicated by overt distress behaviors and pulse rates, than did subjects who received health-education information. Cognitive control did not show a significant effect on self-report of fear. No significant effects were demonstrated for the factor of behavioral control. The results suggested that cognitive control information, which emphasizes the sensory experiences typically accompanying an aversive event, limits reactivity to aversive stimuli. The reduction in reactivity is thought to result in an increased ability to cope with aversive events.